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Risking your life without a second thought: intuitive decision-making and extreme altruism.

ABSTRACT: When faced with the chance to help someone in mortal danger, what is our first response? Do we leap into action, only later considering the risks to ourselves? Or must instinctive self-preservation be overcome by will-power in order to act? We investigate this question by examining the testimony of Carnegie Hero Medal Recipients (CHMRs), extreme altruists who risked their lives to save others. We collected published interviews with CHMRs where they described their decisions to help. We then had participants rate the intuitiveness versus deliberativeness of the decision-making process described in each CHMR statement. The statements were judged to be overwhelmingly dominated by intuition; to be significantly more intuitive than a set of control statements describing deliberative decision-making; and to not differ significantly from a set of intuitive control statements. This remained true when restricting to scenarios in which the CHMRs had sufficient time to reflect before acting if they had so chosen. Text-analysis software found similar results. These findings suggest that high-stakes extreme altruism may be largely motivated by automatic, intuitive processes.

SUBMITTER: Rand DG

PROVIDER: S-EPMC4198114 | biostudies-literature | 2014

REPOSITORIES: biostudies-literature

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Risking your life without a second thought: intuitive decision-making and extreme altruism.

Rand David G DG Epstein Ziv G ZG

PloS one 20141015 10

When faced with the chance to help someone in mortal danger, what is our first response? Do we leap into action, only later considering the risks to ourselves? Or must instinctive self-preservation be overcome by will-power in order to act? We investigate this question by examining the testimony of Carnegie Hero Medal Recipients (CHMRs), extreme altruists who risked their lives to save others. We collected published interviews with CHMRs where they described their decisions to help. We then had ...[more]

PMID: 25333876

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Project description:BACKGROUND:The current vaccine against tuberculosis, BCG, is effective when given in most TB-endemic countries at birth but has diminished efficacy against pulmonary TB after 15-20 years. As a result, new booster vaccines for adolescents and adults are being developed to realize the World Health Organization target of global elimination of TB by 2035. Multiple TB candidates thus are in active clinical development. METHODS:One of these, DAR-901, is advancing in human clinical trials. These clinical trials are conducted in BCG immunized adults with and without HIV infection in order to assess safety and efficacy among the people most in need of a new vaccine. A Phase I dose escalation trial of DAR-901 in BCG-immunized adults with or without HIV infection was conducted between 2014 and 2016. This offered an unusual opportunity to qualitatively examine why foreign-born adults living in the United States - a poorly studied population - decide to participate, or not, in clinical trials. RESULTS:We conducted a qualitative study of individuals who were recruited to participate in this Phase I vaccine trial, interviewing those who agreed and declined to participate. We found diverse motivations for participation or refusal; varied understandings of tuberculosis and vaccines; and complex views about how 'informed consent' can be at odds with cultural understandings of power, authority, and medical decision-making. These dynamics included: knowledge (direct or indirect) of tuberculosis, a desire to be altruistic and simultaneous hopes for personal gain as well as concerns over what remuneration for participation could mean, the importance of personal relationships with care providers in shaping volunteerism, concerns over privacy, and evidence of how culture and history shape medical decision-making. CONCLUSIONS:This US-based trial, aimed at addressing a crucible global health issue, raises productive questions about the interface between altruism and scepticism regarding clinical research participation. TRIAL REGISTRATION:NCT02063555 .

Project description:Importance:Patients with serious illnesses are often encouraged to actively deliberate about the desirability of life support. Yet it is unknown whether deliberation changes the substance or quality of such decisions. Objective:To identify differences in decisions about life support interventions and goals of care made intuitively vs deliberatively by patients with serious illnesses. Design, Setting, and Participants:Randomized clinical trial in which patients were asked to express treatment preferences in a series of clinical scenarios. Participants were 199 hospitalized patients aged 60 years and older with serious oncologic, cardiac, and pulmonary illnesses treated in a large, urban academic hospital from July 1, 2015, through March 15, 2016. Interventions:Patients in the intuitive group were subjected to a cognitive load and instructed to answer each question immediately based on gut instinct. Patients in the deliberative group were not cognitively loaded, were instructed to think carefully about their answers, and were required to explain their answers. Main Outcomes and Measures:Choices regarding life support (4 scenarios) and goals of care (1 scenario), concordance of these choices with patients' valuations of health states that could follow from them, and decisional uncertainty. Results:Of 199 patients, 132 (66%) were male and the mean (SD) age was 67.2 (5.0) years. Similar proportions of patients in the intuitive group (n = 97) and the deliberative group (n = 102) said they would accept a feeding tube for chronic aspiration (42% vs 44%, respectively; difference, -2%; 95% CI, -16% to 12%; P = .79), antibiotics for life-threatening infection in the event of terminal illness (39% vs 43%, respectively; difference, -4%; 95% CI, -18% to 10%; P = .57), a trial of mechanical ventilation (59% vs 60%, respectively; difference,-1%; 95% CI, -15% to 13%; P = .88), and a tracheostomy tube (37% vs 41%, respectively; difference, -4%; 95% CI, -22% to 13%; P = .64). Patients in the deliberative group were slightly more likely than patients in the intuitive group to choose a palliative approach to treatment in the event of serious illness (45% vs 30%, respectively; difference, 15%; 95% CI, 1%-29%; P = .04). Across scenarios, decisional uncertainty was similar between the 2 groups (all P > .05), and intuitive decisions were either equally or more closely aligned with patients' health state valuations than deliberative decisions. Conclusions and Relevance:In this study, encouraging hospitalized patients with serious illnesses to deliberate on end-of-life decisions did not change the content or improve the quality of these decisions. It is important to evaluate whether decision aids and structured communication interventions improve seriously ill patients' choices. Trial Registration:ClinicalTrials.gov Identifier: NCT02487810.

Project description:IntroductionIntuition has been defined as the instantaneous, experience-based impression of coherence elicited by cues in the environment. In a context of discovery, intuitive decision-making processes can be conceptualized as occurring within two stages, the first of which comprises an implicit perception of coherence that is not (yet) verbalizable. Through a process of spreading activation, this initially non-conscious perception gradually crosses over a threshold of awareness and thereby becomes explicable. Because of its experiential basis, intuition shares conceptual similarities with implicit memory processes. Based on these, the study addresses two research questions: (1) Is the gradual nature of intuitive processes reflected on a neural level? (2) Do intuition-based decisions differ neurally from priming-based decisions?MethodsTo answer these questions, we conducted an fMRI study using the triads task and presented participants with coherent word triads that converge on a common fourth concept, and incoherent word triads that do not converge on a common fourth concept. Participants had to perform semantic coherence judgments as well as to indicate whether they immediately knew the fourth concept. To enable investigating intuition-based and priming-based decisions within the same task and with the same participants, we implemented a conceptual priming procedure into the coherence judgment task. We realized this by priming participants with concepts associated with incoherent triads in separate priming blocks prior to the coherence judgments.ResultsFor intuition-based decisions, imaging results mainly revealed activity within the orbitofrontal cortex, within the inferior frontal gyrus and the middle temporal gyrus. Activity suppression in the right temporo-occipital complex was observed for priming-based decisions.ConclusionsWith respect to research question 1, our data support a continuity model of intuition because the two intuitive stages show quantitatively distinct brain activation patterns. Regarding research question 2, we can draw the preliminary conclusion of a qualitative difference between intuition-based and priming-based decisions.

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Risking your life without a second thought: intuitive decision-making and extreme altruism.

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Risking your life without a second thought: intuitive decision-making and extreme altruism.

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